Kareen Dunlop RN.ND. Dip Herbal Med. Grad Dip Acupuncture Grad Cert Nursing Education. Cert Infection Control Nursing Education Naturopathy Acupuncture Herbal Medicine Flower Essences Reflexology Homeopathy Khmer Soviet Friendship Hospital Report December 2017 51 Lemon Gum Drive Mob: +61 41 99 456 91 [email protected] Baldivis WA 6171 Table of Contents I. Executive Summary ............................................................................................... 2 II. Week One .............................................................................................................. 3 III. Week Two .............................................................................................................. 7 IV. Week Three ............................................................................................................ 9 V. Week Four ............................................................................................................. 14 VI. Acknowledgements .............................................................................................. 18 National Infection Control Conference participants The Central Sterilising area now with an actual linen cart (they need more) but at least it is not now sorted on the stairwell and carted on patient trolleys. I was so happy to see the closed doors segregating the various areas of the department from dirty and clean. Executive Summary Returning to the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia where I have been volunteering my time over the last three years, is always with a little bit of trepidation to see if they have managed to sustain what I have taught them as I was repeatedly told by westerners that I would never change them. I must say I have been pleasantly surprised to see that there has been no regression of health care and even improvements in the operating suite. I think one of the key factors of the success of my work, has been not only the real want to improve the hospital by their Director, Prof Meng and his deputy Vicheth but the formation of a Nurse Leadership Team and my continued mentoring of them at a level they can do. During my previous time there I noted there was a great lack of infrastructure to support hand hygiene, one of the most fundamental principles of healthcare. Applecross Rotary had agreed to support a global grant Hand Hygiene Project so along with the support of a great team of local Cambodian’s we have had automatic taps, basins, liquid soap and paper towel dispensers, instrument washing sinks, a backup water pump, public hand hygiene and kitchen sink station installed. I was supposed to return in October, 2107 as part of that project, however the hospital did not have all the public hand basin/kitchen sink in so I ended up tacking that week on to the beginning of this three week period for simplicity’s sake. My first week was spent mainly auditing hand hygiene, ironing out any problems and checking that the project was complete. It has been very pleasing to see on this trip that the majority of staff toilets and clinical areas now have working hand basins with liquid soap. Nursing staff in general that we audited were washing their hands however the medical staff were mainly using alcohol sanitiser (an initiative I had installed in February 2016). Medical staff were also wearing long sleeved coats, watches and rings that meant they were unable to perform hand hygiene correctly. Training initiatives have been put in place to improve this. I also attended the orthopaedic nurses meeting with Mr Tim Keenan on the Friday of that week. The following week Nurse Unit Manager, Samantha Jenaway joined me. The hospital thankfully supported our two national conferences that week – Fundamentals of Operating Theatre Nursing and The Role of Nursing, where we had approximately 110 nurses from all over the country. Both of us also presented at the Calmette Hospital expo. I sat down with the new Chief of Nursing, as Sovannarah retired that Friday (following a minor stroke) to teach him how to manage staff by doing a formal performance review. That weekend we had a lovely trip down with Meng Sok to Siaknouville on the sea coast with plenty of crabs to eat. The next week I spent quite a bit of time meeting with the medical team who support the doctors, to begin encouraging them to report hospital infections. There is a new deputy director, also by the name of Chan Vicheth who is the chair now of the infection control committee. He is a dentist by trade, so I sat with him to teach him the basics of infection control and the importance of reporting infections to have a base line. We also tried to use a formal process to select a new infection control coordinator as the incumbent, Nita was moving to Perth for two years to undertake her masters in public health. At the end of the week I held our second national infection control conference with 150 participants. The final week we visited the Childrens’ Surgical Clinic at their request to feedback to them areas they could improve. A young orthopaedic surgeon from England visiting there had developed a very simple patient information system which is easy to monitor patient infections. Hopefully this will be copied across to the Russian Hospital and I have enticed them to do this by telling them we would find a computer for each department. One of the local Rotarians, Chris Merritt also visited the hospital and we are hoping that a rotary group from the US will take on a waste management project – the next area for improvement. My major focus this trip was to teach them how to report hospital acquired infections and to set the nurse leadership team up with some management tools to assist them to manage their staff. If I am to believe the latest report from the statistical team there death rate has dropped by over 30% since my initial visit, so I am extremely pleased with that. The government have set this hospital up now as the lead hospital for all other hospitals to follow. I now plan to not return for two years mentoring them online from Perth, while I focus on my own growth, both financially and knowledge wise (I plan to start doing my masters in acupuncture research the middle of 2018). This will be a large test for them, however I feel that I have managed with the support of many to set their hospital and many other senior nurses in the right direction. Now I wait with bated breath to see how they manage to stand alone. Operating Room Hand basin now Week One My former time here already included a lot of training in hand hygiene. This has been carried on by the Nurse Leadership Team (NLT) whom I instigated and have been following my instructions in teaching nursing staff how to wash their hands and auditing wards on their compliance. Following implementation of basins, elbow operated auto stop taps, liquid soap and paper towel dispensers, rubbish bins and a poster showing how to wash your hands in Khmer (see picture to the right and the appendix for the poster) throughout the hospital as a global rotary project, I returned to Cambodia to evaluate the effectiveness of this initiative and train where gaps were noted. I wanted to check if the NLT training has been sustainable and Missed area of hand hygiene showing up as effective, so on my first day I secretively placed an ultraviolet fluorescent blue in the UV lit area visible lotion (Glitterbug) on surfaces throughout the urology ward and then later on all the nursing and medical staff’s hands in that ward. Two hours later Pak Sopheak, the Staff Educator and I went round with the ultraviolet torch to check if any of the staff had washed their hands in that period. Interesting Sopheak told me that this particular ward was the worst when they audited previously. So I was pleased that all the nursing staff showed 100% compliance, however not one of the doctors (including medical students) had washed their hands with soap and water. Some told me they had used alcohol. So we had an impromptu class on the difference between alcohol and liquid soap and I later gave a class that afternoon on that subject to the ward. Alcohol is not a cleaner and does not kill some spores such as C.diifficle a common spore causing much issue in hospitals. I noticed this same misunderstanding in the Surgical Intensive Care Unit and Operating Rooms when I audited all staff including doctors. Alcohol hand rinse was the first, cheapest and easiest hand hygiene method I was able to introduce at this hospital two years ago, prior to the hand hygiene project. It is pleasing to see staff using alcohol however I have asked the staff educator to continue training staff on each ward to educate them about when to use alcohol and when to use soap. As part of this education I have designed a when to use soap and when to use alcohol poster (see appendix) that the Infection Control Coordinator (ICC) will translate and add this to their yearly training Teaching the doctors in the Operating Room calendar. Again when auditing the nurses in the operating rooms on all three floors all bar one had excellent hand hygiene (as I hoped as I have taught them previously 1 ½ years ago). So it was great to see their sustained compliance with this. The anaesthetic doctors when I tested them were over vigorous with their hand washing when they knew they were being audited and all did very well. However I did point out to them that I was sure they did not spend so much time washing their hands when not being audited, which raised a few laughs. The Nurse Leadership Team have not done any auditing in this area at all, which is an area for development. I have asked them to do a secret glitterbug audit to check for cleaning and hand hygiene there later in the year and taught them how to evaluate and teach where the gaps are.